Recurrent Periprosthetic Joint Infections: Diagnosis, Management, and Outcomes.

Periprosthetic joint infection (PJI) remains one of the most common complications after total joint arthroplasty. It is challenging to manage, associated with significant morbidity and mortality, and is a financial burden on the health care system. Failure of 2-stage management for chronic PJI is not uncommon. Repeat infections are oftentimes polymicrobial, multiple drug-resistant microorganisms, or new organisms. Optimizing the success of index 2-stage revision is the greatest prevention against failure of any subsequent management options and requires a robust team-based approach.

Implementation of the New Medicare-Mandated Patient-Reported Outcomes After Joint Arthroplasty Performance Measure.

A new mandatory hospital-level, risk-standardized performance measure for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on patient-reported outcomes (THA/TKA PRO-PM) has been implemented by the Centers for Medicare & Medicaid Services (CMS). All THA and TKA in Medicare fee-for-service beneficiaries at inpatient facilities are included. The THA/TKA PRO-PM is the proportion of risk-standardized THA or TKA patients meeting or exceeding the substantial clinical benefit threshold between preoperative and postoperative outcomes measures (Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Knee injury and Osteoarthritis Outcome Score for Joint Replacement). This binary outcome (yes/no) is then divided by all eligible patients creating a percentage of patients reaching substantial clinical benefit. The percentile score among hospitals will be reported. Following 2 voluntary reporting periods, mandatory reporting will begin in 2025. The CMS requires 50% reporting rates; failure leads to annual payment reduction in fiscal year 2028. The CMS intends the THA/TKA PRO-PM to be a patient-centered, meaningful, and relatable measure of hospital performance reported to the public. For surgeons, this is an opportunity to collaborate with hospitals for developing and implementing a THA/TKA data collection system to avoid penalties for the hospital. Further implementation for outpatient surgery and in ambulatory surgery centers has been announced by CMS. Major resources will be needed to succeed in the expected capture rates.

Same-Day Discharge Following Aseptic Revision and Conversion Total Joint Arthroplasty: A Single-Institution Experience.

Background: With hospital inpatient capacity increasingly limited and primary total joint arthroplasty (TJA) rapidly transitioning to outpatient settings, the feasibility of outpatient aseptic revision and conversion TJA (rTJA) has been considered. Before the widespread adoption of outpatient rTJA, guidelines must be established to prevent patient harm. To this end, this study describes our initial experience with same-day-discharge (SDD) aseptic rTJA. Methods: All aseptic rTJAs performed between May 8, 2015, and December 30, 2021, were retrospectively reviewed. Revision indications, patient selection criteria, and outcomes including SDD success rate, predischarge complications, all-cause emergency department visits, inpatient readmissions, and unplanned clinic encounters within 90 days of surgery were recorded. Results: Thirty-five SDD aseptic rTJAs were performed. Conversion total hip arthroplasty (55.0%) and instability (27.3%) were the most common indications for hip revision. Instability (50%) and conversion total knee arthroplasty (20.8%) were most common for knee revision. SDD was achieved in 97% (34/35) of cases. One hip patient failed SDD due to persistent hypoxia requiring an overnight hospital stay and also underwent closed reduction for dislocation in the emergency department within 90 days of discharge. Two additional patients had unplanned clinic encounters within 90 days of the index procedure. There were no hospital readmissions or reoperations within 90 days. Conclusions: Our initial experience suggests SDD aseptic rTJA can be safe and effective when modern perioperative outpatient protocols and surgical techniques are implemented. Future studies should further define patient selection criteria to optimize outcomes and minimize complications in this population.